An exploratory consultation/roundtable, organised by Bernard Lategan and Abdallah Daar, was held on 12 – 14 November at STIAS to look at the potential of digital diagnostics to improve health in Africa. The gathering brought together participants from government, academia, the private health sector, insurance providers, medical schemes, research institutions, technology institutions and others. These participants presented perspectives from Africa and beyond.
The objectives of the roundtable were to brainstorm how digital diagnostic tools based on artificial intelligence (AI) can be used to improve access to healthcare in South Africa and across Africa.
The discussions will help STIAS to make an informed decision on whether to adopt AI/Digital Diagnostics as a new long-term project under STIAS‘ Health in Transition Strategic theme.
Broad discussions and challenges
Topics discussed included: an overview of diagnostics research in South Africa and Africa; an introduction to Ada Health (a mobile app that provides general health information based on questions from users); lessons from scaling up MomConnect (an app offering information to pregnant women in South Africa which was launched in 2014 and currently has 2.8 million users); lessons from scaling up low-income health-insurance products in sub-Saharan Africa; the perspectives of private health delivery organisations, the government, academics, medical aid funds and healthcare leadership; ongoing international research in diagnostic trends in infectious diseases and non-communicable diseases; and, the use of various AI tools to improve access to health.
South Africa is fortunate in having the resources to have a relatively good healthcare system. However, there are challenges including the sheer volume of care needed – for example, in the Western Cape 75% of the province’s population of 6.5 million are dependent on the public-health sector amounting to 17 million health encounters per year. This means longer waiting times for patients to see healthcare providers. Although the provinces use electronic patient-management systems there is a need for better co-ordination and sharing of necessary data.
The situation across the country and between provinces in terms of the availability of skilled professional staff, resources and infrastructure is very variable. It was felt that this could well be improved by digitisation, although even that would pose new challenges which would need to be addressed.
Other issues discussed included the need for more leadership and management resources across medical facilities. These are also areas that could benefit from digital diagnostics and an enabling IT infrastructure and platform across facilities, districts and provinces, allowing for leapfrogging.
The lack of training in digital systems and IT generally in health professional curricula as well as resistance to adopting and relying on such systems needs to be addressed as well as a deeper consideration of the moral and ethical issues around AI-based diagnosis versus human diagnosis.
The need for effective guidelines as well as clinical protocols for enhanced digitisation of healthcare was highlighted. As elsewhere in Africa, collaboration between the public and private sectors under an efficient and fair regulatory system will benefit the country as a whole.
The challenges posed by the regulatory environment in South Africa as well as the importance of quality assurance were also emphasised. There is a need for alignment of healthcare policies throughout the various elements of the health sector regionally and nationally.
Speakers pointed out that serious opportunities exist in the digital area including skills management and task shifting, training, telehealth, etc. but it was repeatedly emphasised that a multidisciplinary approach is needed that includes business, the public sector, healthcare practitioners and health scientists/researchers, engineers and economists. Effective digitisation for the future requires scalability, customisation and cost effectiveness. However, it was emphasised that in the end, the patient’s needs must remain at the core of the decision making. The social and cultural determinants of healthcare are as important as the more technical challenges like app development and upscaling, cost-effective pricing and skills development.
Front: Melvin Moodley, Edward Kirumira, Abdallah Daar, Cameron Meyer, Stan Moloabi, Hila Azadzoy, Peter-John Freeman
Back: Bernard Lategan, Manie de Klerk, Neil Martinson, Imran Mahomed, Gustav Praekelt, Debbie Rogers, André Coetzee, Tyson Welzel, Charles Butler, Sabine Sütterlin
Michelle Galloway: Part-time media officer at STIAS
Photograph: Anton Jordaan